The present invention is directed to the use of compounds with serotonergic 5HT2 agonist activity (Compound) to treat glaucoma, which includes lowering intraocular pressure.
Serotonin (5-hydroxytryptamine; 5HT) is an endogenous biogenic amine with a well defined neurotransmitter function in many tissues of the body including the eye [Zifa and Fillion, Pharmacol. Rev., 44, 401 (1992); Hoyer et al., Pharmacol. Rev., 46, 157 (1994); Tobin et al., J. Neurosci., 8, 3713 (1988)].
5HT can interact with at least seven major 5HT receptors (5HT1-5HT7) and additional subtypes within these families to initiate intracellular biochemical events such as stimulation of second messengers (e.g. cAMP, inositol trisphosphate) eventually leading to the final biological response, for example, tissue contraction or hormone release, etc. [Hoyer et al., supra; Martin et al., Trends Pharmacol. Sci., 19, 2 (1998)]. Receptor subtypes within the 5HT1 family are negatively coupled to adenylyl cyclase (AC) and cause inhibition of cAMP production, while 5HT4, 5HT6, and 5HT7 receptors are positively coupled to AC and thus stimulate cAMP production when activated by 5HT [Martin et al., supra]. The 5HT3 receptor is unique in that it couples to an ion channel which gates sodium, potassium, and calcium [Hoyer et al., supra].
The receptors in the 5HT2 family are positively coupled to phospholipase C (PLC) and thus generate inositol phosphates and mobilize intracellular calcium when activated by 5HT. The 5HT2 receptor classification consists of the 5HT2A, 5HT2B, and 5HT2C receptor subtypes, all of which have highly homologous amino acid sequences. The receptor previously referred to as 5HT1C in an earlier nomenclature (prior to about 1990), has been reclassified as the 5HT2C receptor because of its greater similarity with other PLC coupled receptors of the 5HT2 family, based on molecular cloning and its pharmacological characteristics (Hoyer, et al, 1994).
Serotonergic nerves innervate the eye [Tobin et al., J. Neurosci., 8, 3713 (1988)] and 5HT has been found in the aqueous humor of human eyes [Martin et al., Ophthalmol., 95, 1221 (1988)]. In addition, receptor binding sites for. [3H]5HT have been demonstrated and pharmacologically characterized in the iris-ciliary body (ICB) of rabbits [Mallorga and Sugrue, Curr. Eye Res., 6, 527 (1987) and Chidlow et al., Invest. Ophthalmol. Vis. Sci., 36, 2238 (1995)]. These 5HT binding sites have been shown to be functionally coupled to second messenger generation in rabbits [Tobin and Osborne, J. Neurochem., 53, 686 (1989) and Tobin et al., J. Neurosci, supra]. In the human ICB these binding sites are characterized as 5HT1A and 5HT2 receptors [Barnet and Osborne, Exp. Eye Res., 57, 209 (1993)]. In addition, the presence of mRNAs for 5HT1A and 5HT7 receptors in the rabbit ICB have been reported [Chidlow et al., Invest. Ophthalmol. Vis. Sci., supra and Osborne and Chidlow, Ophthalmologica, 210, 308 (1996)]. The precise functions of these receptors in the eye are unknown.
5HT or 5-carboxamidotryptamine (5-CT) topically applied to the rabbit eye raise intraocular pressure (IOP) [Meyer-Bothling et al., Invest. Ophthalmol. Vis. Sci., 34, 3035 (1993)]. By contrast, another group has shown that topically applied 5HT decreased IOP in the rabbit; however, when 5HT was administered to the rabbit intracarnerally it resulted in an increase in IOP and caused breakdown of the blood-aqueous barrier [Krootila et. al., J. Ocular Pharmacol., 3, 279 (1987)]. In addition, the 5HT uptake inhibitor, fluoxetine (Prozac(copyright)), also raises IOP in human subjects upon oral administration [Costagliola et al., Br. J Ophthalmol., 80, 678 (1996)] and may cause glaucoma [Ahmad Ann. Pharmacother., 25, 436 (1992)]. However, the 5HT receptor subtype(s) involved in the IOP-elevating effects of 5HT, 5-CT and fluoxetine are unknown.
Studies conducted in rabbits with 8-hydroxy DPAT and MKC-242 (5HT1A agonists) have shown these compounds lower IOP [Osborne and Chidlow Ophthalmologica, 210, 308 (1996), and EP 0771563-A2]. In addition, 5-methylurapidil (5HT1A agonist) lowered IOP in glaucomatous monkeys [Wang et al., Curr. Eye Res., 16, 679 (1997)]. Both MKC-242 and 5-methylurapidil are relatively potent xcex11 receptor antagonists (xcex11 antagonists are known to lower IOP in rabbits, monkeys, and man). The mechanism of action for lowering IOP by 5-methylurapidil has been attributed to its xcex11 antagonist activity and not its 5HT1A agonist activity [Wang et al., Invest. Ophthal Vis. Sci., 39(Suppl), 2236 (1998)]. U.S. Pat. No. 5,693,654, discloses 5HT1-like (now designated 5HT1D) receptor agonists, such as sumatriptan, for lowering IOP. WO92/20338 discloses certain 5HT1A antagonists for the treatment of glaucoma.
Methysergide (5HT2 antagonist, but with other activities) lowered IOP in rabbits [Krootila et al., Exp. Eye Res., supra]. Ketanserin (5HT2A/C antagonist), also with significant xcex11 antagonist activity, lowers IOP in rabbits and man [Chan et al., J. Ocular Pharmacol., 1, 137 (1985) and Costagliola et al., Exp. Eye Res., 52, 507 (1991)]. Saprogrelate (5HT2A antagonist) lowers IOP in rabbits and in man when dosed topically or orally [Mano et al., Invest. Ophthal. Vis. Sci., 36(Suppl), 3322 (1995) and Takenaka et al., Invest Ophthal. Vis. Is Sci., 36(Suppl), 3390 (1995)]. EP 522226 and U.S. Pat. No. 5,290,781 disclose the use of ketanserin and its derivatives for treating ocular hypertension. U.S. Pat. Nos. 5,290,781 and 5,106,555 disclose the use of certain 5HT2 antagonists for lowering IOP. U.S. Pat. No. 5,652,272 discloses saprogrelate for reducing IOP. U.S. Pat. No. 5,538,974 discloses ophthalmic compositions of certain 5HT2 antagonists for lowering IOP. WO/9911619 discloses 5HT2A antagonists which may be efficacious in treating glaucoma.
U.S. Pat. No. 5,011,846 discloses certain 5HT3 receptor antagonists for treating glaucoma.
WO 97/17345 discloses that particular compounds with 5HT4 serotonergic receptor agonist or antagonist activity are useful for treating psychiatric, gastrointestinal, lower urinary, and cardiovascular disorders. The publication mentions the compounds may also be useful for glaucoma.
As evidenced by the previous discussion, it is not clear which serotonergic receptor activity is responsible for lowering IOP. Moreover, a number of these compounds are known to have activity at non-serotonergic receptors which are known to be involved in lowering IOP.
The present invention is directed to the use of compounds with 5HT2 receptor agonist activity to treat glaucoma, which includes lowering intraocular pressure. Compositions of the compounds are contemplated for such uses.
Unexpectedly, it has been found that serotonergic compounds which possess agonist activity at 5HT2 receptors effectively lower and control elevated IOP and are useful for treating glaucoma.
Specific compounds which exemplify the present invention include: 1) (R)4-iodo-2,5 dimethoxy-xcex1-methyl-benzeneethanamine [(R)-DOI], the prototypical selective 5HT2 agonist which is not selective amongst the 5HT2 receptor subtypes [Baxter et al., Trends. Pharmacol. Sci., 16, 105 (1995)]; 2) xcex1-methyl-serotonin, a potent 5HT2 agonist with modest receptor subtype selectivity: 5HT2B greater than 5HT2C greater than 5HT2A [Baxter, et al., supra]; 3) 5-methoxy-xcex1-methyltryptamine, with a profile similar to that of xcex1-methyl-serotonin [Nichols et al., J. Med. Chem., 31, 1406 (1998)]. The following references are not limiting, but rather exemplify Compounds useful according to the present invention and are incorporated herein by reference: U.S. Pat. Nos. 5,861,425; 5,646,173; 5,578,612; 5,571,833; 5,545,644; 5,494,928; 4,659,706 and 4,487,773; published European Patent Specification No. 863,136; published International Patent Application Nos. WO98/56768; WO98/31354; WO98/30548; WO98/30546. Additionally, compounds disclosed in the following publications further exemplify Compounds useful according to the present invention and are also incorporated herein by reference: Parker et al, J. Med. Chem. 41, 5148 (1998); Vangveravong et al, J. Med. Chem. 41, 4995 (1998); Albertini et al, Mutagenesis, 13, 397 (1998); Monte et al, J. Med. Chem. 40, 2997 (1997); Bxc3x6s et al., Eur. J. Med Chem., 32, 253 (1997); Bxc3x6s et al., J. Med. Chem., 40, 2762 (1997); Monte et al, J. Med Chem. 39, 2952 (1996); Glennon et al., J Med. Chem., 37, 1929 (1994); Macor et al, Tetrahedron Lett. 35, 45 (1994); Macor et al, J. Med Chem. 35, 4503 (1992); Macor et al. J. Med. Chem., 35, 3625 (1992); Glernon et al, J. Med. Chem. 35, 734 (1992); Seggel et al. J. Med Chem. 33, 1032 (1990).
It is recognized that many of the aforementioned Compounds have asymmetric atoms, therefore all enantiomers and diastereomers are contemplated. Also contemplated are pharmaceutically acceptable salts as well as the free bases of the Compounds. The Compounds are administered to the eye (e.g., topically, intracamerally, or via an implant). The Compounds are preferably incorporated into topical ophthalmic formulations for delivery to the eye. The Compounds may be combined with ophthalmologically acceptable preservatives, surfactants, viscosity enhancers, penetration enhancers, buffers, sodium chloride, and water to form an aqueous, sterile ophthalmic suspension or solution. Ophthalmic solution formulations may be prepared by dissolving a Compound in a physiologically acceptable isotonic aqueous buffer. Further, the ophthalmic solution may include an ophthalmologically acceptable surfactant to assist in dissolving the Compound. Furthermore, the ophthalmic solution may contain an agent to increase viscosity, such as, hydroxymethylcellulose, hydroxyethylcellulose, hydroxypropylmethylcellulose, methylcellulose, polyvinylpyrrolidone, or the like, to improve the retention of the formulation in the conjunctival sac. Gelling agents can also be used, including, but not limited to, gellan and xanthan gum. In order to prepare sterile ophthalmic ointment formulations, the active ingredient is combined with a preservative in an appropriate vehicle, such as, mineral oil, liquid lanolin, or white petrolatum. Sterile ophthalmic gel formulations may be prepared by suspending the active ingredient in a hydrophilic base prepared from the combination of, for example, carbopol-940, or the like, according to the published formulations for analogous ophthalmic preparations; preservatives and tonicity agents can be incorporated.
The Compounds are preferably formulated as topical ophthalmic suspensions or solutions, with a pH of about 5 to 8. The Compounds will normally be contained in these formulations in an amount 0.01% to 5% by weight, but preferably in an amount of 0.25% to 2% by weight. Thus, for topical presentation 1 to 2 drops of these formulations would be delivered to the surface of the eye 1 to 4 times per day according to the routine discretion of a skilled clinician.
The Compounds can also be used in combination with other agents for treating glaucoma, such as, but not limited to, xcex2-blockers, prostaglandins, carbonic anhydrase inhibitors, xcex12 agonists and miotics. The Compounds can also be used with calcium channel blockers and antagonists for metabotropic and ionotropic glutamate receptors and/or antagonists for their associated binding sites, such as, the polyamine and strychnine-insensitive glycine sites. These agents may be administered topically, but usually systemically.
A particularly preferred combination includes the use of a Compound with an xcex12 adrenergic agent, such as, apraclonidine or brimonidine or their pharmaceutically acceptable salts.
Compounds useful in this invention can be identified using methodology well known to one skilled in the art. The selection is made first by using a 5HT2 receptor binding assay, an example of which is described below. Compounds of this invention posses high affinity for 5HT2 receptors (IC50 or Ki values of about 20 nM or less and this affinity is higher than at other 5HT receptors). The second part of this selection is made based on the functional activity of the compound as described below. Compounds of this invention possess agonist EC50 values of about 1 xcexcM or less. Antagonists are not contemplated in this invention.
Both of these methods are believed to be the best way to identify a compound that would be useful according to this invention; however, it is important to note that some compounds that are identified by these methods may not be as desirable as others as commercial products. One must take into account the nature of the compound in question in terms of its structure, physical propertiesxe2x80x94e.g., solubility, lipophilicity, and chemical stability and its susceptibility to be metabolized to an inactive compound (or compounds) within the eye. The impact of these parameters is well known to one skilled in the art and can be determined using methods well known in the art.
In addition to the above discussion, certain 5HT2 agonists such as DOI, its isomers, and related compounds are known to cause central nervous system (CNS) side effects in man when dosed systemically. In the present invention it is believed that the Compounds can be dosed topically, at a low enough dose to lower and control IOP, but not cause unwanted CNS side effects which may be associated with some Compounds. Some Compounds are particularly desirable because their physical properties keep them from penetrating the CNS and causing side effects. Also, certain Compounds of this invention may cause local irritation and discomfort upon topical ocular administration that render them less desirable than other more comfortable compounds. This can be readily determined using methods well known in the art.